Got a Bad Back? Social Security Act Disorders of the Spine

Posted on Jan 03, 2017 By James Ezzell

James EzzellI have mentioned the “listings” several times in my past blog entries as they relate to Social Security disability. If you recall, when evaluating disability applications, the Social Security Administration employs a five-step sequential process to determine if an individual meets several required benchmarks to be awarded benefits.

Social Security Act “Listings”

The first two, whether an individual is working and has he or she been diagnosed with a severe impairment, are usually easily enough determined. The third step is where the process gets tricky: Does an individual have a severe impairment that meets or equals a “listing?”

1.04 Disorders of the Spine

I thought I would focus on one particular listing today, 1.04 Disorders of the spine, as the majority of our clients seem to have bad backs. There are a variety of specific diagnoses that can be identified as the source of back pain, bulging discs, pinched nerves, etc., for example.

For what it’s worth, the most common back ailment seems to be Degenerative Disc Disease, which is just that, the progressive degeneration of discs over time. It is not really a disease, however, but simply a physical condition that just about everyone develops as we age.

Here is the 1.04 Disorders of the spine listing in full:

1.04 Disorders of the spine (e.g., herniated nucleus pulposus, spinal arachnoiditis, spinal stenosis, osteoarthritis, degenerative disc disease, facet arthritis, vertebral fracture), resulting in compromise of a nerve root (including the cauda equina) or the spinal cord. With:
A. Evidence of nerve root compression characterized by neuro-anatomic distribution of pain, limitation of motion of the spine, motor loss (atrophy with associated muscle weakness or muscle weakness) accompanied by sensory or reflex loss and, if there is involvement of the lower back, positive straight-leg raising test (sitting and supine);

OR

B. Spinal arachnoiditis, confirmed by an operative note or pathology report of tissue biopsy, or by appropriate medically acceptable imaging, manifested by severe burning or painful dysesthesia, resulting in the need for changes in position or posture more than once every 2 hours;

or

C. Lumbar spinal stenosis resulting in pseudoclaudication, established by findings on appropriate medically acceptable imaging, manifested by chronic nonradicular pain and weakness, and resulting in inability to ambulate effectively, as defined in 1.00B2b.

While many of our clients have been diagnosed with one or more of these back problems, keep in mind that it is the severity of the condition that counts. Just having a diagnosis is not enough, we must show that its associated symptoms meet or are functionally equal to the above elements.

Quite often, our client’s doctor — even if he or she is a specialist — does not produce notes that contains all these items that the SSA requires. Accordingly, we often ask that the claimant’s primary treating physician write a “letter of support” that tracks the appropriate language in the listing to fill in the gaps. Even with this in hand, we will often still have to attend a hearing which, in and of itself, can be an excruciating experience.

If you or your child have been denied SSA disability benefits or suffer from a severe impairment that is expected to last more than twelve months and that prevents you from doing any of your past or other work or is causing developmental delay in your child, please contact our office nearest to you to set up a free consultation appointment to discuss your situation.